The specific aim of the proposed research is to analyze data from a hypertensive population which began treatment almost 20 years ago, seeking predictors of mortality, hospitalization and ESRD. The population, consisting of more than 11,000 disadvantaged and largely indigent veterans, began treatment following the identification of untreated hypertensives in a large scale screening program. Half of the population was black; almost half of the population has died with deaths identified through either the VA's Beneficiary Identification Records Location Subsystem (BIRLS) or the National Death Index (NDI). ESRD has been identified by matching patients to the USRDS Dialysis and Transplant Registry and, from the VA's Patient Treatment File (PTF). Prior analyses have suggested significant interclinic differences in mortality. In addition to geographic variability and case mix differences, other explanatory variables will be examined, including characteristics of the clinics delivering the treatment, urban vs rural nature of the patients, and the presence of trace elements in the soil and water. Records of early treatment will be utilized to examine how compliance with therapy, blood pressure, and pharmaceutical regimens utilized related to subsequent morbidity and mortality. Analysis of two additional samples, one drawn from participants in the program at a later date and the other mild hypertensives enrolled in a randomized clinical trial, will be utilized to replicate findings and increase generalizability of the results.